Recommended immunization schedule for children and adolescents age 7 through 18 years – United States, 2025 (for those who fall behind or start late, refer to UpToDate content related to the catch-up schedule)

1vCOV-mRNA: monovalent mRNA COVID-19 vaccine; 1vCOV-aPS: adjuvanted, protein subunit COVID-19 vaccine; anti-HBs: hepatitis B surface antibody; COVID-19: coronavirus disease 2019; DEN4CYD: Dengvaxia; IIV3: trivalent inactivated influenza vaccine; LAIV3: trivalent live attenuated influenza vaccine; MenACWY-CRM: Menveo; MenACWY-TT: MenQuadfi; MenACWY-TT/MenB-FHbp: Penbraya; MenB-4C: Bexsero; MenB-FHbp: Trumenba; mIU: milli-international units; MMRV: combined measles, mumps, rubella, and varicella vaccine (ProQuad); MMWR: Morbidity and Mortality Weekly Report; mRNA: messenger ribonucleic acid; PCV13: 13-valent pneumococcal conjugate vaccine; PCV15: 15-valent pneumococcal conjugate vaccine; PCV20: 20-valent pneumococcal conjugate vaccine; PPSV23: Pneumovax 23.

* Adolescent vaccine age groups.

¶ Tetanus and diphtheria toxoids, and acellular pertussis (Tdap) vaccination

• Adolescents age 11 through 12 years: 1 dose Tdap.
• Pregnancy: 1 dose Tdap during each pregnancy, preferably in early part of gestational weeks 27 through 36.
• Tdap may be administered regardless of the interval since the last tetanus- and diphtheria-toxoid-containing vaccine.
• Wound management: Refer to https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm for vaccination indications as part of wound management.

Δ Human papillomavirus (HPV) vaccination

• Routine vaccination:
  • HPV vaccination routinely recommended at age 11 through 12 years (can start at age 9 years) and catch-up HPV vaccination recommended for all persons through age 18 years if not adequately vaccinated.
  • 2- or 3-dose series depending on age at initial vaccination:
    • Age 9 through 14 years at initial vaccination: 2-dose series at 0 and 6 to 12 months (minimum interval: 5 months; repeat dose if administered too soon).
    • Age 15 years or older at initial vaccination: 3-dose series at 0, 1 to 2 months, and 6 months (minimum intervals: dose 1 to dose 2: 4 weeks; dose 2 to dose 3: 12 weeks; dose 1 to dose 3: 5 months; repeat dose if administered too soon).
  • No additional dose recommended after completing series of any valency using recommended dosing intervals.
• Special situations:
  • Immunocompromising conditions, including HIV infection: 3-dose series, even for those who initiate vaccination at age 9 through 14 years.
  • History of sexual abuse or assault: Start at age 9 years.
  • Pregnancy: Pregnancy testing not needed before vaccination. HPV vaccination not recommended until after pregnancy; no intervention needed if vaccinated while pregnant.

◊ Meningococcal serogroup A, C, W, Y (MenACWY) vaccination

• Routine vaccination:
  • 2-dose series at 11 through 12 years and 16 years.
• Catch-up vaccination:
  • Age 13 through 15 years: 1 dose now and booster at age 16 through 18 years (minimum interval: 8 weeks).
  • Age 16 through 18 years: 1 dose.
• Special situations:
  • Healthy children ages 16 through 23 years may receive the pentavalent vaccine (MenACWY-TT/MenB-FHbp [Penbraya]) when both MenACWY and MenB are indicated at the same visit. In this situation, a booster dose of MenB-FHbp (Trumenba) should be used to complete the MenB series because the 2 MenB-component vaccines are not interchangeable.
  • Refer to UpToDate content related to meningococcal vaccines and immunization in specific high-risk groups. High-risk conditions include anatomic or functional asplenia (including sickle cell disease); HIV infection; persistent complement component deficiency; complement inhibitor (eg, eculizumab, ravulizumab) use; travel to countries with hyperendemic or epidemic meningococcal disease, including countries in the African meningitis belt or during the Hajj (refer to www.cdc.gov/travel); first-year college students who live in residential housing (if not previously vaccinated at age 16 years or older); and military recruits.
  • Children ≥10 years with high-risk conditions may receive a single dose of Penbraya when both MenACWY and MenB are indicated at the same visit and they have not received a dose of Penbraya within the previous 6 months. If booster doses are required <6 months apart, the boosters will need to be administered as individual doses of MenACWY and MenB-FHbp.
  • Menveo has 2 formulations: lyophilized and liquid. The liquid formulation should not be used before age 10 years.

§ Meningococcal serogroup B (MenB) vaccination

• Adolescents not at increased risk age 16 through 23 years (preferred age 16 through 18 years) based on shared decision-making, particularly those about to attend college:
  • Bexsero or Trumenba (use same brand for all doses): 2-dose series (0 and 6 months) or 3-dose series (0, 1 through 2, and 6 months).
  • Penbraya (the pentavalent vaccine) may be used instead of MenB and MenACWY when both are indicated at the same visit. In this situation, a booster dose of MenB-FHbp (Trumenba) should be used to complete the MenB series because the 2 B-component vaccines are not interchangeable. MenB vaccine choices and dosing intervals can be found in the table included with the publication of the pentavalent vaccine recommendations.
• Special situations:
  • Anatomic or functional asplenia (including sickle cell disease), persistent complement component deficiency, complement inhibitor (eg, eculizumab, ravulizumab) use:
    • Bexsero or Trumenba (use same brand for all doses including booster doses): 3-dose series at 0, 1 to 2, and 6 months (if dose 2 was administered at least 6 months after dose 1, dose 3 not needed; if dose 3 is administered earlier than 4 months after dose 2, a 4^th dose should be administered at least 4 months after dose 3).
  • Children ≥10 years with high-risk conditions may receive Penbraya when both MenACWY and MenB are indicated at the same visit and if they have not received a dose of Penbraya within the previous 6 months. If booster doses are required <6 months apart, the boosters will need to be administered as individual doses of MenACWY and MenB-FHbp.
• NOTE: Bexsero and Trumenba are not interchangeable; the same product should be used for all doses in a series.
• For additional information, refer to UpToDate content on meningococcal vaccines and immunization in the specific high-risk group.

¥ COVID-19 vaccination

• Age 7 through 11 years:
  • Unvaccinated: 1 dose of updated (2024-2025 formula) Moderna or Pfizer-BioNTech vaccine.
  • Previously vaccinated with 1 or more doses of Moderna or Pfizer-BioNTech: 1 dose of updated (2024-2025 formula) Moderna or Pfizer-BioNTech at least 8 weeks after the most recent dose.
• Age 12 through 18 years:
  • Unvaccinated: 1 dose of updated (2024-2025 formula) Moderna or Pfizer-BioNTech vaccine or 2-dose series of updated (2024-2025 formula) Novavax at 0 and 3 through 8 weeks.
  • Previously vaccinated before 2024-2025 vaccine available with any COVID-19 vaccine(s):
    • 1 or more doses of Moderna or Pfizer-BioNTech: 1 dose of any updated (2024-2054 formula) COVID-19 vaccine at least 8 weeks after the most recent dose.
    • 1 dose Novavax: 1 dose of updated (2024-2025 formula) Novavax 3 to 8 weeks after the most recent dose. If more than 8 weeks after the most recent dose, administer 1 dose of 2024-2025 Novavax, Moderna, or Pfizer-BioNTech.
    • 2 or more doses of Novavax: 1 dose of 2024-2025 Novavax, Moderna, or Pfizer-BioNTech at least 8 weeks after the most recent dose.
• Moderately or severely immunocompromised:
  • Age 7 through 11 years, unvaccinated: 4 doses (3-dose initial series at 0, 4 weeks, and at least 4 weeks after dose 2 of updated [2024-2025 formula] Moderna or 3-dose initial series at 0, 3 weeks, and at least 4 weeks after dose 2 of updated [2024-2025 formula] Pfizer-BioNTech), followed by 1 dose of 2024-2025 Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
  • Age 7 through 11 years, previously vaccinated with:
    • 1 dose of Moderna: Complete initial series with 2 doses of updated (2024-2025 formula) Moderna at least 4 weeks apart (minimum interval between previous dose and dose 1: 4 weeks), followed by 1 dose of 2024-2025 Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 2 doses of Moderna: Complete initial series with 1 dose of updated (2024-2025 formula) Moderna at least 4 weeks after most recent dose, followed by 1 dose of 2024-2025 Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 1 dose of Pfizer-BioNTech: Complete initial series with 2 doses of updated (2024-2025 formula) Pfizer-BioNTech at least 4 weeks apart (minimum interval between previous dose and dose 1: 3 weeks), followed by 1 dose of 2024-2025 Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 2 doses of Pfizer-BioNTech: Complete initial series with 1 dose of 2024-2025 Pfizer-BioNTech at least 4 weeks after the most recent dose, followed by 1 dose of 2024-2025 Moderna or Pfizer-BioNTech 6 months later (minimum interval 2 months).
    • 3 or more doses before 2024-2025 vaccine available of Moderna or Pfizer-BioNTech: 2 doses of updated (2024-2025 formula) Moderna or Pfizer-BioNTech 6 months apart (minimal interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose.
  • Age 12 through 18 years, unvaccinated:
    • 4 doses (3-dose initial series Moderna at 0, 4 weeks, and at least 4 weeks after dose 2, followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later [minimum interval 2 months]).
    • 4 doses (3-dose initial series Pfizer-BioNTech at 0, 3 weeks, and at least 4 weeks after dose 2, followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later [minimum interval 2 months]).
    • 3 doses (2-dose initial series at 0 and 3 weeks of updated [2024-2025 formula] Novavax, followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later [minimum interval 2 months]).
  • Age 12 through 18 years, previously vaccinated with:
    • 1 dose of Moderna: Complete initial series with 2 doses of updated (2024-2025 formula) Moderna at least 4 weeks apart (minimum interval between previous dose and dose 1: 4 weeks), followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later (minimum interval 2 months).
    • 2 doses of Moderna: Complete initial series with 1 dose of updated (2024-2025 formula) Moderna at least 4 weeks after the most recent dose, followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later (minimum interval 2 months).
    • 1 dose of Pfizer-BioNTech: Complete initial series with 2 doses of updated (2024-2025 formula) Pfizer-BioNTech at least 4 weeks apart (minimum interval between previous dose and dose 1: 3 weeks), followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later (minimum interval 2 months).
    • 2 doses of Pfizer-BioNTech: Complete initial series with 1 dose of updated (2024-2025 formula) Pfizer-BioNTech at least 4 weeks after the most recent dose, followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later (minimum interval 2 months).
    • 1 dose of Novavax: Complete initial series with 1 dose of updated (2024-2025 formula) Novavax at least 3 weeks after the most recent dose, followed by 1 dose 2024-2025 Moderna, Pfizer-BioNTech, or Novavax 6 months later (minimum interval 2 months).
    • 3 or more doses before 2024-2025 vaccine available of Moderna or Pfizer-BioNTech: 2 doses of 2024-2025 formula) Moderna, Pfizer-BioNTech, or Novavax 6 months apart (minimum interval 2 months).Administer dose 1 at least 8 weeks after the most recent dose.
    • 2 or more doses before 2024-2025 vaccine available of Novavax: 2 doses of 2024-2025 formula Moderna, Pfizer-BioNTech, or Novavax 6 months apart (minimum interval 2 months). Administer dose 1 at least 8 weeks after the most recent dose.
• For additional recommendations, refer to https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html.
• NOTE: Administer an age-appropriate vaccine product for each dose. Current COVID-19 schedule and dosage formulation available at www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.

‡ Influenza vaccination

• Use any influenza vaccine appropriate for age and health status annually (refer to UpToDate content on influenza vaccination in children and ACIP recommendations):
  • 2 doses, separated by at least 4 weeks, for children age 7 through 8 years who have received fewer than 2 influenza vaccine doses before July 1, 2024, or whose influenza vaccination history is unknown (administer dose 2 even if the child turns 9 years between receipt of dose 1 and dose 2).
  • 1 dose for children age 7 years through 8 years who have received at least 2 influenza vaccine doses before July 1, 2024.
  • 1 dose for all persons age 9 years or older.
  • 18-year-old solid organ transplant recipients who are receiving immunosuppressive medications: High-dose inactivated (HD-IIV3) and adjuvanted inactivated influenza vaccines (aIIV3) are acceptable options, with no preference over other age-appropriate inactivated or recombinant influenza vaccines.
• For the 2024-2025 season, refer to the 2024-2025 ACIP influenza vaccine recommendations.
• For the 2025-2026 season, refer to the 2025-2026 ACIP influenza vaccine recommendations.

† Pneumococcal vaccination

• Special situations:
  • High-risk conditions: Refer to separate UpToDate content and ACIP recommendations for information on pneumococcal vaccination in children with high-risk conditions.
  • High-risk conditions include cerebrospinal fluid leak; chronic heart disease; chronic kidney disease (excluding maintenance dialysis and nephrotic syndrome, which are included in immunocompromising conditions); chronic liver disease; chronic lung disease (including moderate persistent or severe persistent asthma); cochlear implant; diabetes mellitus; immunocompromising conditions (on maintenance dialysis or with nephrotic syndrome; congenital or acquired asplenia or splenic dysfunction; congenital or acquired immunodeficiencies; diseases and conditions treated with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, Hodgkin disease, and solid organ transplant; HIV infection; and sickle cell disease or other hemoglobinopathies).

** Haemophilus influenzae type b (Hib) vaccination

• Special situations:
  • Refer to UpToDate content related to Hib vaccination and immunization in specific high-risk groups. Special situations and high-risk groups include chemotherapy or radiation treatment, hematopoietic cell transplant, anatomic or functional asplenia (including sickle cell disease), elective splenectomy, HIV infection, immunoglobulin deficiency, and early component complement deficiency.

¶¶ Hepatitis A (HepA) vaccination

• Catch-up vaccination:
  • Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).
  • Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.
  • Adolescents age 18 years or older may receive the combined HepA and HepB vaccine (Twinrix) as a 3-dose series (0, 1, and 6 months) or a 4-dose series (3 doses at 0, 7, and 21 to 30 days, followed by a booster dose at 12 months).
• International travel: Persons traveling to or working in countries with high or intermediate endemic hepatitis A:
  • Unvaccinated age 12 months or older: Administer dose 1 as soon as travel is considered.

ΔΔ Hepatitis B (HepB) vaccination

• Catch-up vaccination:
  • Unvaccinated persons should complete a 3-dose series at 0, 1 to 2, and 6 months.
  • Adolescents age 11 through 15 years may use an alternative 2-dose schedule with at least 4 months between doses (adult formulation Recombivax HB only).
  • Adolescents 18 years or older may receive:
    • Heplisav-B: 2-dose series at least 4 weeks apart.
    • PreHevbrio: 3-dose series at 0, 1, and 6 months.
    • Combined HepA and HepB vaccine (Twinrix): 3-dose series (0, 1, and 6 months) or 4-dose series (3 doses at 0, 7, and 21 to 30 days, followed by a dose at 12 months).
• Special situations:
  • Revaccination is generally not recommended for persons with a normal immune status who were vaccinated as infants, children, adolescents, or adults.
  • Postvaccination serology testing and revaccination (if anti-HBs <10 mIU/mL) is recommended for certain populations, including:
    • Persons who are predialysis or on maintenance dialysis.
    • Other immunocompromised persons.
  • For detailed revaccination recommendations, refer to https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm.
• NOTE: PreHevbrio is not recommended in pregnancy due to lack of safety data in pregnant persons.

◊◊ Inactivated poliovirus (IPV) vaccination

• A 4^th dose of IPV is indicated if all previous doses were administered at <4 years or if the 3^rd dose was administered <6 months after the 2^nd dose.
• IPV is not routinely recommended for United States residents age 18 years or older.

§§ Measles, mumps, and rubella (MMR) vaccination

• Catch-up vaccination:
  • Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart.
  • Partially vaccinated children and adolescents: 1 dose at least 4 weeks after the previous dose.
  • Maximum age for use of MMRV vaccine: 12 years.
  • Minimum interval between MMRV doses: 3 months.
• International travel:
  • Unvaccinated children and adolescents: 2-dose series at least 4 weeks apart before departure.

¥¥ Varicella (VAR) vaccination

• Ensure persons 7 through 18 years without evidence of immunity (refer to MMWR Recomm Rep 2007; 56(RR04):1) have a 2-dose series.
  • Age 7 through 12 years: Routine interval: 3 months (a dose inadvertently administered after at least 4 weeks may be counted as valid).
  • Age 13 years or older: Routine interval: 4 to 8 weeks (minimum interval: 4 weeks).
  • Maximum age for use of MMRV: 12 years.

‡‡ Respiratory syncytial virus (RSV) vaccination

• 1 dose administered to pregnant people at 32 weeks 0 days through 36 weeks and 6 days gestation starting in September (1 to 2 months before the anticipated start of the RSV season) and continuing through January (2 to 3 months before the anticipated end of the RSV season) in most of the continental United States. Providers should follow state, local, or territorial guidance on the timing of maternal RSV vaccination.
  • Vaccine is not administered to pregnant persons between February and August.
  • Vaccine may be administered to persons who have previously had an RSV infection.
  • Additional doses are not recommended during subsequent pregnancies.
• Refer to CDC and health department guidance for timing of vaccine administration in jurisdictions with RSV seasonality that differs from most of the of the continental United States.

For more details, refer to https://www.cdc.gov/mpox/hcp/vaccine-considerations/vaccination-overview.html.

†† Dengue vaccination

• Routine vaccination:
  • Age 9 through 16 years living in dengue endemic areas and have laboratory confirmation of previous dengue infection: 3-dose series administered at 0, 6, and 12 months.
  • Endemic areas include Puerto Rico, American Samoa, United States Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau. For updated guidance on dengue endemic areas and prevaccination laboratory testing, refer to the ACIP recommendations and https://www.cdc.gov/dengue/index.html.
  • Dengue vaccine should not be administered to children traveling to or visiting endemic dengue areas.

*** Mpox vaccination

• At risk for mpox infection: 2-dose series, 28 days apart.
• Risk factors include:
  • Persons who are gay, bisexual, men who have sex with men, transgender, or nonbinary who in the past 6 months have had:
    • A new diagnosis of at least 1 sexually transmitted infection.
    • More than 1 sex partner.
    • Sex at a commercial sex venue.
    • Sex in association with a large public event in a geographic area where mpox transmission is occurring.
  • Persons who are sexual partners of the persons described above.
  • Persons who anticipate experiencing any of the situations described above.